Compounded inequality: racial disparity and Down syndrome
Authors: Eimear McGlinchey, M Florencia Iulita, Juan Fortea
Journal: The Lancet Public Health (2023)

People with Down syndrome continue to face health inequities. A recent Article in The Lancet Public Health1Baksh RA Pape SE Chan LF Aslam AA Gulliford MC Strydom A Multiple morbidity across the lifespan in people with Down syndrome or intellectual disability: a population-based cohort study using electronic health records.Lancet Public Health. 2023; 8: e453-e462Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar reported distinct age-specific disease trajectories, risk profiles, and clustering of diseases in people with Down syndrome. R Asaad Baksh and colleagues call for much-needed adjustments to health-care guidance to improve outcomes for this population.1Baksh RA Pape SE Chan LF Aslam AA Gulliford MC Strydom A Multiple morbidity across the lifespan in people with Down syndrome or intellectual disability: a population-based cohort study using electronic health records.Lancet Public Health. 2023; 8: e453-e462Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar We fully support this call and additionally emphasise the critical need to address racial disparities in this population, otherwise there is a risk that this tailored health-care guidance will not benefit everyone with Down syndrome. We recently reported2Iulita MF Garzón Chavez D Klitgaard Christensen M et al.Association of Alzheimer disease with life expectancy in people with Down syndrome.JAMA Netw Open. 2022; 5e2212910Crossref Scopus (28) Google Scholar vulnerability to racial inequalities in people with Down syndrome, with vast disparities in the mortality rates between Black people with Down syndrome and White people with Down syndrome, particularly for infants and middle-aged adults; this difference was greater than that observed in the general population.3Caraballo C Massey DS Ndumele CD et al.Excess mortality and years of potential life lost among the black population in the US, 1999–2020.JAMA. 2023; 329: 1662-1670Crossref PubMed Scopus (0) Google Scholar As highlighted by Baksh and colleagues, a lack of awareness of different disease patterns means that treatable conditions can go untreated. For Black people with Down syndrome, disparities due to both race and intellectual disability further compound inequity. Alzheimer's disease is the most frequent comorbidity in people with Down syndrome. Alzheimer's disease is currently incurable, but this might change with disease-modifying therapies. Equitable access to these medications is, therefore, critical for the whole population of people with Down syndrome, but particularly for Black individuals. Without equitable access, we risk further widening the gap between Black people and White people with Down syndrome. Individuals with Down syndrome are among those most at risk of disparities, and Black individuals with Down syndrome might be the best indicator of success (or failure) in our fight to promote health equity. EMG reports grants from the Alzheimer's Association, the Global Brain Health Institute, and the Health Research Board. JF reports grants from Generalitat de Catalunya; the National Institute on Aging of the US National Institutes of Health; Fundació Tatiana Pérez de Guzmán el Bueno; Alzheimer's Association (USA); Fondo de Investigaciones Sanitario, Instituto de Salud Carlos III; BrightFocus; Horizon 2020 (European Commission); personal fees from AC Inmune, Lundbeck, Lilly, Esteve, Roche, Laboratorios Carnot, and Novartis, outside the submitted work; and a patent entitled, Markers of synaptopathy in neurodegenerative disease (EP18382175.0 pending). MFI reports grants from the Alzheimer's Association and is a full-time employee of Altoida.